Rural, urban schools address medical needs with onsite centers |
On Board Online • May 13, 2013
By Cathy Woodruff
Senior writer
Whether it’s time for a routine sports physical or a tetanus shot, a wheezing episode that could signal an asthma attack or a sore throat that might be a strep infection, Laurens Central School students don’t have to go far for medical attention.
Help is just down the hall.
“It’s quality health care right where the kids are,” Superintendent Romona Wenck says of the district’s School-Based Health Center.
The Laurens School-Based Health Center (SBHC) is among 19 operated by the Cooperstown-based Bassett Healthcare Network., the state’s largest provider of school-based health care in rural communities.
In all, there are 228 SBHCs throughout New York, with three-quarters of the centers operating in urban areas, according to the state Health Department. But the centers also are gaining recognition as a way to reach rural children who otherwise would lack regular access to physical health care and mental health treatment.
“School-based health centers are truly one of my favorite school and healthcare reforms,” said John W. Sipple, director of the New York State Center for Rural Schools at Cornell University, noting that there’s rarely any controversy about their value to students.
“Educators, parents, nurses and physicians all agree that this is a tremendously efficient and valuable way to remove the many health-related factors that can keep children from reaching their full potential,” Sipple said. “No longer is access to health care and health information a struggle for parents and children in these districts, but, rather, a seamless part of their school day.”
Students made some 30,000 visits to Bassett school-based centers in 2012, according to Bassett officials. With fewer than 350 students, Laurens, which is in Otsego County, is the smallest of the 14 districts that host Bassett SBHCs. The largest, with close to 1,600 students, is Sherburne-Earlville in Chenango County.
The centers are physically indistinguishable from a typical doctor’s office. They are staffed by nurse practitioners, nurses, dental hygienists, clinical social workers, medical office assistants and consulting physicians.
In Laurens, the SBHC is adjacent to the office of the school nurse, who works collaboratively with the Bassett employees. Even though state law requires districts to have school nurses on staff, they are prohibited from providing many of the services that the independently operated medical office can.
“The services at the health center are far above what the mandates would provide,” said Wenck.
There is no charge to children or their families for care provided at the centers. Insurance may be billed for visits, but no co-pays or other fees are collected from patients, and the staff can help families of uninsured children apply for coverage through New York’s Child Health Plus, Medicaid or other sources. (Regular payment policies do kick in if a student is referred elsewhere for an x-ray, needs a prescription filled at a local pharmacy or requires other care beyond what can be provided at the school-based center.)
An SBHC can be the primary healthcare provider for a student or it can offer a backup option for those times when it’s not practical for a student to get to the family’s regular doctor. At Laurens, nearly 90 percent of students are enrolled at the school health center, which also offers mental health and dental hygiene services.
Dr. Chris Kjolhede, a pediatrician who is director of Bassett’s SBHC program and the collaborating physician on the Laurens center staff, says it’s typical for well-established programs to exceed 90 percent student enrollment.
“They may not all be users, but they are enrolled with us, just in case,” he said.
Kjolhede said the conditions he treats run a gamut of pediatric practice, ranging from common conditions, such as strep throats, ear infections and ankle sprains, to rarer ones, such as anorexia. Last year, a student with Duchene’s Muscular Dystrophy began treatment at one of the centers. The condition already had been diagnosed, Kjolhede said, “but it wasn’t being managed well.”
Nearly a third of the care provided through the center is mental health treatment, said Jane Hamilton, a registered nurse and manager of the Bassett SBHC program. The mental health staff provides counseling and/or medication management for chronic conditions, such as depression, anxiety, Attention Deficit Hyperactivity Disorder and Post Traumatic Stress Disorder, and for crisis-prompted issues, such as grief.
SBHC clinical social workers work closely with the Department of Psychiatry at Bassett, Hamilton said, but being able to meet students in their schools greatly aids therapy and expands the potential benefits.
“There are children who struggle with issues that really affect their performance in school,” she said. “Because we are in the environment the kids are in every day, we are able to make some of those observations that practitioners at outside clinics aren’t able to make. That gives us some insight. We can give them (coping) strategies because we’re right there.”
Kjolhede, who works in multiple schools, said routine physical checkups and care visits also offer opportunities to spot hidden mental health issues. He had noted three cases of “cutting,” a self-injuring behavior that can be a symptom of some mental disorders, in just the previous week, he said.
Concern about poor student access to mental health care was what reinvigorated interest in establishing an SBHC in Richfield Springs, said Superintendent Robert Barraco. An effort several years ago stumbled because of lack of start-up funding, he said.
Supporters are hopeful that a $150,000 Aid to Localities appropriation secured by Sen. James Seward (R-Oneonta) in this year’s state budget will inspire others to contribute to the estimated $300,000 cost of building and equipping a center at the school.
Bassett’s entire SBHC program has an annual operating budget of $3.6 million.
While Bassett administrators aim to come as close to breaking even as possible, the school-based health program usually does operate at a loss, said Dr. William F. Streck, Bassett President and CEO. In 2012, the difference between costs and revenue from grants and insurance coverage was $152,000, and those losses were covered as part of Bassett’s overall expenses, he said.
As a non-profit, Bassett subsidizes the school-based health program as part of its community service responsibility, Streck said. But the greater motivation, he said, is that “it’s the right thing to do. Most of these children otherwise wouldn’t get the primary care they need.”
National advocates say more funding is needed for school-based health care, and there are some signs that the message is resonating with state and federal officials.
The 2013-14 state budget includes $15 million in competitive grant funding to encourage creation of “community schools” that offer social, health and after-school programs in distressed communities. One of the best-known models for such programs is the Harlem Children’s Zone.
Meanwhile, the federal Affordable Care Act authorizes $50 million in operating funds for SBHCs, according to the National Assembly on School-Based Health Care, but the money has not yet been included in the 2014 fiscal year budget.
Wenck, the Laurens superintendent, sees no good argument against expanding health care in the nation’s schools. Her own two sons are enrolled at the Laurens SBHC.
“Every single parent, in my opinion, should have their child enrolled in the School-Based Health Center,” Wenck said. “It’s like a safety net.”